Epidemiology of Ovarian Masses among teenagers in Mansoura University Hospitals

Background: The estimated prevalence for ovarian masses in the pediatric and adolescent age is 2.6 cases out of 100,000 each year. Clinical Symptoms might be a helpful tool in the diagnosis of ovarian masses despite their non-specificity and overlapping between different ovarian masses. The basic principles for managing ovarian masses in teenagers should be to define mass major characteristics, to manage functional cysts conservatively by avoiding any unnecessary surgery for them and to rule out malignancy. Objective: To analyze epidemiology of ovarian masses in teenagers admitted at Mansoura University Hospitals. Methods: This cross-sectional study has been carried out in the department of obstetrics and gynecology at Mansoura University Hospitals throughout the period 2018. The study included 76 patients aged between thirteen and nineteen years with a diagnosis of ovarian mass by ultrasonography or CT or MRI, those patients below the age of thirteen and those above the age of nineteen were excluded from the study. Results: During the study period, 76 patients were diagnosed with ovarian masses. The age of patients ranged from 13 to 19 years (median, 16.63±2.2 years). Many patients underwent more than one diagnostic procedure owing to the varied nature of presented symptoms; however, pelvic ultrasound was most commonly performed. Accuracy of diagnosis by ultrasound was (89.8%); accuracy of diagnosis by MRI was (87.5%) while CT was not accurate in the case performed in it, which pathology turned out to be hemorrhagic infarction of the ovary. CA125 was done in 20 cases and its level raised in 2 cases, one turned out to be benign neoplasm (cystadenofibroma) and the other case was malignant neoplasm (immature teratoma). Alpha-fetoprotein (AFP) was done in 11 patients, and the level raised in only one of them histopathology of which turned out to be immature teratoma. LDH was done in 6 patients, and its level raised in 4 of them including 2 benign neoplasms, their histopathology turned out to be mucinous cystadenoma and fibrothecoma and 2 malignant neoplasms, their pathology turned out to be dysgerminoma and granulosa cell tumor. ALP was done in 3 patients and its level raised in two of them, one turned out to be benign neoplasm (cystadenofibroma) and the other case was malignant neoplasm (immature teratoma). B-HCG was done in 9 patients, and none of them had a rise. CEA was done in 4 patients, and none of them had a rise. Conclusion: Adolescents benefit from conservative management of ovarian cysts because ovarian cysts are more likely to be benign. If surgical approach is mandatory, the aim should be preservation ovarian tissue in order to preserve fertility and allow normal pubertal development. Detorsion of the torsed ovary is the ideal procedure even if the ovary appears necrotic. The laparoscopic approach is effective and safe for managing benign adnexal masses in adolescents.